Twenty Mississippi hospitals have filed a civil lawsuit against the companies that manufacture and distribute opioids and drugstore chains such as Walmart, Walgreens and CVS pharmacies that sell opioid-based drugs, according to the SunHerald. Mississippi is one of the top five states for opioid distribution per capita, according to the lawsuit, with 92.9 prescriptions written for every 100 people in 2017, compared to the national average of 58.7 per 100. The lawsuit claims that companies “knowingly and intentionally” concealed facts from the medical community and spent millions on “a misinformation campaign.”
Sunflower, a subsidiary of Centene, will be required to issue more than $25 million in health insurance rebates to nearly 19,000 Kansans who purchased Ambetter individual health plans, reports KCUR. The rebates are required by the Affordable Care Act (ACA), which specifies that insurers must spend a certain proportion of what they collect in premiums — usually 80 percent — on their members’ healthcare. The rest can go toward the company’s own costs and profits. Sunflower’s hefty refund puts Kansas’ average rebate at more than $1,000, or seven times the national average. The state’s insurance department, which regulates premiums, has asked Sunflower for information about how it landed so far above the ACA threshold.
In 2018, Massachusetts met the Total Health Care Expenditures benchmark set by the Health Policy Commission, growing by 3.1 percent to $8,827 per resident, according to analysis by the Center for Health Information and Analysis. The report also notes that the public insurance program, MassHealth, launched its accountable care organization (ACO) program in 2018 and shifted more than 60 percent of its members to an ACO in that year. Alternative payment model (APM) adoption declined slightly among commercial health plans in 2018, especially within smaller plans.
California enacted a first-in-the-nation state law to combat pay-for-delay deals, in which brand-name pharmaceutical manufacturers pay a generic competitor to settle patent litigation and keep a lower-cost version of the drug off the market, reports NASHP. Delaying market entry of generic drugs can keep prices for brand-name drugs high, costing California consumers an estimated $3.5 billion in higher drug costs each year.
Prisma Health Greenville Memorial Hospital will be the first hospital in South Carolina to offer home recovery care, designed to keep patients out of the hospital by bringing key elements of inpatient care directly to their homes, according to GSA Business Report. Home recovery care is often beneficial for individuals suffering from non-life threatening, acute medical conditions, and may lower stress and reduce recovery time. So far, eligible patients using the model at other health systems have accepted the option at a 90 percent rate – the care model has resulted in a 44 percent reduction in readmission rates when compared to hospital care delivered in a traditional acute setting.
In an effort to make healthcare more affordable, Blue Cross Blue Shield and Sanitas Medical Center will offer a full-service clinic to provide primary care, urgent care, lab and diagnostic imaging services, care coordination and wellness and disease management programs in one location, according to Chron. They hope the primary-care driven, value-based model will reduce costs by providing affordable access to preventable care, thereby preventing the need for more serious treatment down the line. The key, the organizations believe, is working together to improve healthcare as a whole.
Blue Cross and Blue Shield of North Carolina and Cambia Health Solutions will drop their plans to combine, following the resignation of the North Carolina insurer's chief executive, Patrick Conway, according to the Wall Street Journal. These insurers had initially planned to combine and generate $16 billion in annual revenue, covering over six million people through Blue Cross Blue Shield plans - the new entity was to be lead by Conway.
For the first time since Colorado opened its health insurance exchange, people will see a drop in coverage prices, according to the Canon City Daily Record. Coverage costs across the state will drop by an average of 20.2 percent. In western Colorado, which has some of the highest health insurance premiums in the U.S., a family of four will save an average of $10,000 per year, according to the Colorado Division of Insurance. The main reason for the price cut is the state’s new reinsurance program, which uses $260 million in state and federal funding to cover some of the most expensive medical costs for those who purchase plans through the marketplace.
The Wisconsin Office of the Commissioner of Insurance reports that people in Wisconsin who purchase health insurance on the ACA exchange will have more choices in 2020, according to the Milwaukee Journal Sentinel. The number of insurers selling health plans will increase to five, up from three in 2017. Officials believe that the increased competition on the exchange will keep price increases in check and could even lead to price decreases for the following year.
Thousands of former patients at Deaconess and Valley hospitals will have medical debts erased as part of a major legal settlement with Community Health Systems (CHS), a struggling for-profit hospital chain, according to The Spokesman-Review. The settlement comes more than two years after the Empire Health Foundation sued CHS, alleging the company failed to provide the levels of charity care that it had promised when buying the hospitals from Empire Health Services in 2008. CHS also agreed to pay the foundation $20 million to create a political lobbying arm, the Empire Health Community Advocacy Fund.